Luegina A. Drones
Summary
Detail oriented self starter with excellent written and verbal communication skills. Capability of working individually or in a group setting. Able to learn new tasks quickly while multitasking and working in a fast-paced environment. Experienced Clinical Administrative Coordinator well-versed in handling clerical, case management and claims reviews in busy healthcare environments. Highly organized and detail-oriented with excellent planning and communication skills. Prepared to offer [Number] years of related experience to a challenging new role with room for advancement.
Overview
25
25
years of professional experience
Work History
Clinical Administrative Coordinator
Enterprise Clinical Services Optum
12.2012 - Current
- Inbound/outbound calls to hospitals
- Eligibility verification in ICUE
- Complete pregnancy outcome assessments daily
- Complete 350+ cases per month
- Extract and review faxes
- Management of queue for incoming deliveries
- Review clinical information to determine high risk level
- Review clinical information to determine extended length of stay
- Refer medical cases to medical management team
- Maintain 100% on monthly audits
- Ensure timely processing of cases within the 24 hr
- TAT
- Complete yearly U-Learns
- Attend weekly team huddles
- Attend quarterly town hall meetings
- Attend monthly 1:1 with manager
- Provide coverage for team members
- Manage emails
- Collaborate with case management on challenging cases
- Data entry
- Monitor and update master facility list
- Verify member's eligibility in Facets
- Claims research
- Other administrative
Case Management Associate
UnitedHealthcare- Clinical Services
07.2006 - 12.2012
- Assist case managers by making initial contact with members
- Complete non-clinical assessment to determine if member is eligible for outpatient services
- Route case to case manager depending on outcome of non-clinical assessment
- Verify eligibility of member through the state verification line
- Assist with claim resolution
- Resubmission of claims for payment
Administrative Assistant
UnitedHealthcare- Specialized Care Services
03.1999 - 07.2006
- Assist the Care Coordination Team
- Ensured all data and measurement components of the program were completed accurately and in a timely manner
- Coordinated gathering and distribution of monthly ululation reports
- Coordinated
- The accuracy and completion of care coordinators logs i.e denial /appeal and referral log
- Assisted the outbound non-clinical calls
- Scheduled and maintain records of Care Coordinators Team meetings
- Collaborated and communicated with other members of the Care Coordination team to improve processes efficiency and effectiveness
- Made travel arrangements for management
- Tracked departmental expenses
- Prepared presentations for meetings
- Ensured all patient files were secure and confidential
- Ordered supplies as needed for the department
- Created and maintained access database
Education
Associate - Healthcare Management
Ashworth College
Skills
- Windows Office Applications: Excel, Access, PowerPoint, Word, Outlook, knowledge of CPT and ICD codes Medical Transcription
- Records Reviews
- Transcription
- Recordkeeping Skills
- Claims Assessments
- Supply Oversight
- Provider Relations
Timeline
Clinical Administrative Coordinator
Enterprise Clinical Services Optum
12.2012 - Current
Case Management Associate
UnitedHealthcare- Clinical Services
07.2006 - 12.2012
Administrative Assistant
UnitedHealthcare- Specialized Care Services
03.1999 - 07.2006
Associate - Healthcare Management
Ashworth College
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